New Forehead, New Confidence: Flap Advancement Post-cancer Excision

Basal cell carcinoma (BCC) often affects sun-exposed regions, such as the forehead. Surgical excision with histopathologically confirmed clear margins remains the gold standard for treating BCC, especially for high-risk or recurrent cases. Wide local excision ensures complete tumor removal while minimizing the risk of recurrence. However, reconstructing defects in the forehead poses unique challenges due to limited excess skin, high tension, and the presence of muscles. Reconstruction strategies must prioritize preserving functional and cosmetic outcomes, including motor and sensory nerve integrity, and maintaining proper camouflaging incision lines and eyebrow position in relaxed skin tension lines (RSTLs). For large defects, a combination of multiple local tissue flaps is often favored over skin grafting, as it restores facial contours with adjacent, similar tissue and yields higher success rates with fewer complications. This report discusses a case of wide local excision of a BCC over the forehead, followed by defect reconstruction using advancement flaps from the temporal regions.